While You Are Waiting for Reform

While we all wait for reform, we can busy ourselves with RAC audit preparation.

Revenue Audit Contractors are upon the land, working on contingency to find all of the waste and fraud in the health care system.

Since most of you have so little to do anyway, we should be thinking about how to prepare for and respond to RAC auditing.

After the New Year we will be publishing a checklist format paper on how to cope with RAC. The link will be here.

Happy New Year!

Google Your Practice Name

If you are lucky the first results will be your practice website and links to favorable news articles.

If you are not so lucky, you may hit websites where patients can complain about physicians, or maybe an employee's Facebook page.

You need to know.

CER Hits a Snag

Comparative Effectiveness Research (CER) may have inadvertently lost credibility even before health care reform is actually launched.

CER is the darling of the government-dominated health reform movement (not a government take-over, to be clear). The use of evidence-based medicine when combined with cost-benefit analysis has the potential to save a great deal of money while better serving the patients. Many see downsides though; too rigid protocols and interference with physician judgment, or the dirty “R” word, rationing.

The U.S. Preventive Services Task Force recently released a study on various breast cancer screening modalities, recommending more limited screening protocols, particularly delaying routine mammography until age 50 (except in women with unusual risk factors).

Kah – boom!

USPSTF points out film mammography does cut mortality, with the greatest reductions in women over 50, with the best results in the age 60 – 69 cohort. Film mammography does carry a risk of false positives and the pain and inconvenience of unnecessary biopsies.

USPSTF also recommends ceasing mammography on women over 74, citing a lack of reliable evidence of reduced mortality.

There was a huge backlash from women, physicians, cancer activists and some health care associations.

USPSTF also recommends against teaching women to perform ”breast self-exam” (BSE) which has been a standard tool for decades. More backlash.

USPSTF does point out that digital and MRI mammography do not show, at this time, significant improvement over film mammography, but do have greater costs.

None of the conclusion appear to have been made on strong and startling statistics, but on think pros and cons, as one might expect from quants and scientists.

Women apparently want a little less quant and a lot more consideration.



USPSTF report:
http://www.annals.org/content/151/10/716.full

cross-posted at: http://healthcarethinktank.blogspot.com/

HIPAA Security Alert

HIPAA Horrors


The Blade (Toledo) reports on October 28th an imaging technician was arrested in Ohio for driving infractions and possession of marijuana.

During the arrest the police scanned his cell phone.

In his phone were photos of dozens of partially clad patients preparing for imaging tests, including minors.

Wow.

The penalties and lawsuits are likely to be massive.

HIPAA Security Alert

Does your practice sell or trade-in used cell phones?

If you do, you MUST scrub the data from the phones before you trade them.

Health Care Reform Part 2

President Obama's speech yesterday was "hitting the reset button" for health care reform.

First impressions - the numbers do not add up.

And every President since Nixon has promised to reduce "waste, fraud and abuse" from Medicare and Medicaid.

Game on!

HIPAA Security Social Nightmares

Facebook ™, Myspace ™, Twitter ™ and millions of web logs (“blogs”) are connecting people worldwide, and that includes your employees.

Some business organizations are using these social networks, some not, but either way it is a good bet your employees are using these sites to connect with and expand their social networks.

That can be a huge problem!

Employees used to flashing every aspect of their lives on-line are very likely to discuss work on-line as well.

Social networks sites create a huge risk for HIPAA violations, and also for employee problems (some of the comments posted can be incredibly vicious),

HIPAA is 24/7!

No, you cannot control your employees lives, EXCEPT as it relates to work.

Every health care organization should develop policies and procedures on the use of social networking sites for the broadcast of work related information. Soon.

Obesity and More

For years physician offices have dealt with the obese, and in a few cases the morbidly obese.

These days, there are the obese patients, the morbidly obese (100% over ideal body weight), and now the super morbidly obese (our terminology).

Patients weighing in excess of 300 pounds are very common, and patients more than 400 pounds are more common. Over a certain level patients are unlikely to present at the office, lacking the mobility.

Many became obese due to mobility problems, most develop worse mobility problems due to the weight, a vicious cycle.

Some issues to consider:

Waiting room chairs may not be suitable for the patients.

Securing extra large wheel chairs.

Scales may be inadequate or unsafe to use.

Patients may not be able to sit on exam tables.

X-ray positioning is problematic, and clean image may not be possible.

Staff must be trained on sensitivity and safety issues.

Physician Comment Sites Cause Controversy

According to the Washington Post (July 21, 2009) websites where patients can compliment or criticise physicians are not so popular with some physicians.

Sites such as http://www.ratemds.com/, http://www.drscore.com/, and generic consumer sites such as Angie's List are causing phsycians to require "no-comment" agreements from new patients.

The sites, in the form of open community bulletin boards, allow patients to compliment or slam physicians. Similar sites exist for other professions and services.

None of the information posted is verified for truthfullness, so just about anything can be written for the public to view.

Not all physicians are so hostile to such sites, but in a profession built on reputation this could be a bothersome trend.

Back Door Reimbursement Cuts for Docs?

The federal government is concerned about the incidence of Medicare re-admissions.

Typical scenario: an elderly patient is admitted to the hospital for pneumonia and related distress. After a four day stay the patient is discharged to a long-term care facility.

A week later the patient is re-admitted with acute distress, after the nurse requests orders from the patient’s physician. After several days the patient is again discharged to the nursing home.

This cycle is very costly to Medicare, and the feds would like to see it slow down.

(Based on conversations with long-term care nurses and reviews of Minimum Data Set (MDS) summaries, the patients are usually very old, very frail, but not at death’s door quite yet.)

One solution is to ‘train” physicians and families not to be so quick to send the patient back to the hospital. This is tough on families, who often pressure the physician to readmit. Sometimes the patient demands readmission, it is easy for the physician to say yes. This situation can also be tough on the nursing home, where higher acuities are colliding with the nursing shortage.

A proposed solution is bundling. President Obama mentioned it in his 6/15 speech to the AMA. How does it work? The hospital gets a flat fee per incidence and then has to pay the physician, nursing home, ambulance/transport company, physical therapist, etc.

This requires a lot of administrative work and some intense negotiations, and puts the hospital at risk, and creates tension between physicians and the hospital.

Could this work? Maybe. Good for patients? Unknown. Good for physicians? Probably not.

Briefing Paper: Email and electronic communications

The first in a series of briefing papers on administrative topics:

http://www.scribd.com/doc/16018098/Email-Briefing-Paper-Health-Care

Selling Health Care Reform

President Obama is selling health care reform with the argument that we need to fix health care in order to fix the overall economy.

Economic advisor Christina Romer distributed an op-ed piece today explaining how health care reform would 1) improve family incomes, 2) enhanced GDP, 3) lower budget deficits, 4) lower unemployment, 5) provide greater health care coverage (of course) and a 6) better labor market.

Wow. This is quite a claim.

Full report: http://www.whitehouse.gov/assets/documents/CEA_Health_Care_report.pdf

Denial Management

Denial management (whether the denials are based on substance, stalling or practice error) is a key part of revenue cycle management. Some quick tips:

1) every denial should be logged in

2) every denial should have an answer date assigned

3) there should be clear responsibility for answering the denials

4) denials should be compiled for trend analysis, especially practice errors and denials by payer

5) prompt pay laws should be used when applicable (although be careful about starting wars with payers)

6) summaries should be prepared monthly and reviewed for management action


If a practice is behind on denial management, create a strategy to catch up, focusing on the most probable collections and the highest value claims.

The Blog Family

Now we have a blog family………


Health Care Reform and Public Policy

http://healthcarethinktank.blogspot.com/

healthcarethinktank@gmail.com


Physician Group Practice Management Topics

http://practicemanagementnews.blogspot.com/

practicemanagementnews@gmail.com


Long-term Care Management News

http://longtermcareupdates.blogspot.com/

longtermcareupdates@gmail.com

HIPAA Security - Alert #3

Disposing of Computers:

A British research group bought about 300 used computers from on-line sources and second hand stores.

The purpose was to search for confidential data on hard drives.

Among other data, the researchers found top secret classified U.S. military defense plans. Oops!

Used practice computers should not be sold or discarded unless the hard drive is removed or a real expert "wipes" the hard drive. Using the computers standard "delete" function does not wipe the information from the drive.

Old hard drives that cannot be wiped are best removed from the machine and "fixed" with a large hammer, and then disposed of in a pile of trash not likely to attract the curious.

This advice goes as well for portable devices of all kinds.

Shredder Talk

The original shredder models cut paper in strips and neatly deposited the strips into a bag or box.

The U.S. State Department eventually learned the shredding could, with enough patience, be reconstructed (in 1979 several hundred Iranian students reassembled thousands of documents during the Iranian hostage crisis).

The FBI and other law enforcement agencies have found the reconstruction technique quite useful. An accountant was recently indicted for tax evasion after shredding in his trash was reconstructed.

Someone diving in your practice dumpster could also reconstruct strip shredded documents.

New shredders are double-cut, creating confetti instead of strips. While not impossible, this confetti would be very difficult to reconstruct.

We highly recommend the double-cut shredders.

Plastic Surgery Sagging

Plastic surgeons have made fortunes on private pay patients seeking elective surgeries.

The recession has apparently hit hard enough to lower demand for plastic surgery services.

We recently saw a billboard with discount package prices for breast enhancement and lipo.

Based on media reports, there may be one growth area in plastic surgery - fixing botched plastic surgery.

This is a serious recession!

HIPAA Security - Passwords

The ideal password is something like this:

682Tj0327Jr486

Numbers, letters, upper case, lower case - good strong security.

But there is a problem.

Try memorizing the password. Try to remember it for a day. You probably cannot.

If you require your employees to have complex passwords they will write the password somewhere, probably on a sicky note, and put it where they can find it.

If the employee can find the written password, so can someone else.

A six digit password with both letters and numbers may be a better alternative (the number prevents the use of cat names, kid names, etc.).

OSHA Workplace Violence Procedures

The tragic shooting spree at a Carthage North Carolina nursing home is a reminder of the OSHA requirement for a workplace violence program, applicable for not only nursing homes but other health care providers as well.

No program can stop a crazy killer or an armed robber, but training employees to react properly can hasten the arrival of police and the protection of residents.

Medical groups handle a great deal of cash, and some groups and ASCs have narcotics on the premises. These can be magnets for criminals and the deranged. Unhappy patients and relatives of employees also can be threats.

OSHA fact sheet:

http://www.osha.gov/OshDoc/data_General_Facts/factsheet-workplace-violence.pdf

HIPAA Security Alert #2

Mobile devices are E-V-I-L.

Several scandals have erupted when cell phone cameras were used inappropriately in health care facilities.

In a couple of cases, improper photos were placed on social networking sites (such as Facebook).

But even with good intent, cell phones, I-phones (and imitators) PDAs and laptops are walking potential HIPAA violations.

First advice:

No devices may contain practice data without prior approval.

No clinical emails may be forwarded unless within established policy.

More advice to follow.....

HIPAA Security Alert #1

How did top secret plans for the Presidential helicopter get to Iran?

An employee of a defense contractor had P2P file sharing software on his computer.

P2P networks, such as BitTorrent or Limewire, are often used by young people to trade songs and videos, and may open your system to access by any hacker in the world.

These file sharing program should never be installed on business computers, let alone computers full of confidential patient data.

Your network should be audited for unauthorized software, and no one (including the physicians) should be allowed to download or install unauthorized software on any practice desktop, laptop or server.

And those cute screensaver programs that pop up on your screen? During a download you are likely to get spyware and adware, or maybe something worse.

Business computers should be all business.

New Adventure

Our healthcarethinktank blog was going to cover health care reform and health care management, but clearly there is too much material for one blog.

So here we are, with a second blog dedicated to health care management issues, focused on physician practice management, and useful to other types of providers as well.